Are Daily Habits Damaging Your Teeth?

Some of the habits developed by children and adult alike over time may cause damage to the teeth that will not immediately show or manifest but will build up over the years, which will be harmful to their overall dental health in the long run. Here is a list of practices you may want to avoid.

Oral Disease: Herpes Labialis

What Causes Herpes Labialis?

Herpes simplex virus (HSV), after primary oral or perioral infection, remains latent in the trigeminal ganglion. HSV moves down the trigeminal nerve to produce mucocutaneous lesions if reactivated by factors such as:

Familial Adenomatous Polyposis (FAP)

What is FAP?

FAP—an autosomal dominant condition caused by mutation in the APC tumour suppressor gene on chromosome 5—is characterized by the development during the second decade of life of hundreds of adenomas in the colon and rectum. These eventually cause rectal bleeding or anaemia, or develop into cancer.

A less aggressive variant—termed attenuated FAP, is characterized by fewer colorectal adenomatous polyps (usually 10–100), a later age of denoma appearance and a lower cancer risk.

What are the Symptoms of FAP?

FAP is initially symptomless but later gastrointestinal features appear. Extraintestinal manifestations may include osteomas, dental anomalies (unerupted teeth, agenesis of one or more teeth, supernumerary teeth, dentigerous cysts and odontomas), congenital hypertrophy of retinal pigment epithelium, desmoid tumours and extracolonic cancers (thyroid, liver, bile ducts and central nervous system).

Where there are skull and mandible osteomas, dental abnormalities and fibromas on scalp, shoulders, arms and back, the term Gardner syndrome is employed.

How is FAP Diagnosed?

Clinical plus imaging and colonic polyp biopsy.

How is FAP Treated?

The intestinal polyps have a 100% risk of undergoing malignant transformation: therefore, the early identification of disease and colectomy is critical.


Reference: Scully C. 2010. Oral and Maxillofacial Disease. Vol. 4th Ed. Informa Healthcare. UK.

Dental Anasthesia: Posterior Superior Alveolar Nerve Block

The posterior superior alveolar (PSA) nerve is a branch of the maxillary division of the trigeminal nerve. It parts from the main trunk in the pterygopalatine fossa, passes inferiorly along the posterior wall of the maxilla, and enters the bone about 1 cm superior and posterior to the third molar tooth. The PSA nerve supplies the buccal gingivae, periodontium, and alveolus associated with the upper molar teeth. It provides innervation to the pulps of all the upper molar teeth with the possible exception of the mesiobuccal pulp of the first molar, which is supplied by the middle superior alveolar (MSA) nerve in approximately 50% of individuals.

Branches of the maxillary nerve

Injection for the PSA nerve block is performed in a highly vascular area, and formation of a hematoma is a recognized side effect, especially when the needle is advanced more than 15 mm. Immediate hemorrhage is controlled by pressure, but postinjection trismus may last for weeks. Antibiotic therapy should be prescribed if the hematoma is large. 

Technique: Posterior Superior Alveolar Nerve Block

1. Use a short or long needle, no less than 27 gauge.
2. Instruct the patient to open the mouth only slightly, and move the lower jaw over to side of injection.
3. Retract the lip and cheek with the thumb or first finger of left hand.
4. Insert the needle at the height of the maxillary buccal sulcus at distal aspect of second
   molar.
5. Advance the needle posteriorly, superiorly, and medially (at 45-degree angle to each plane) to a depth 15 mm.
6. Perform aspiration.
7. Inject 1.5 ml of solution slowly.
8. If bone is contacted before a depth of 1.5 ml achieved, alter the angle of approach by
   withdrawing slightly and positioning the syringe medially.

Normal orientation of needle for posterior superior alveolar nerve block. From Jastak JT, Yagiela JA, Donaldson D: Local anesthesia of the oral cavity, Philadelphia, 1995, Saunders.

Palpation of zygomatic process in posterior superior alveolar nerve block. Point of needle insertion lies within mucosal pocket posterior to palpating finger.

 

Source : Dionne RA. 2002. Management of Pain and Anxiety in the Dental Office. W.B. Saunders. Philadelphia

How Hypnosis Can Manage Pain and Anxiety in the Dental Office

Hypnosis is a formalized method of applying the techniques of attention modification, paced breathing, and muscle relaxation. It has been employed in dentistry for more than 100 years. Highly regarded courses in hypnosis for clinicians are available on a regional basis from the American Society of Clinical Hypnosis. The courses are graded from beginner to advanced. A beginner’s course will equip the clinician with skills that can be used the next day in practice. A hypnosis course is an easy way to practice talking to patients about a more comfortable way to experience dental treatment.

The process of helping a patient reach a hypnotic state is called induction, as described in the following example:

The patient should be relaxed and sitting up.

Dentist: Please make yourself comfortable. You must be comfortable to get relaxed.
Do you feel comfortable now?

Patient: Yes.

Dentist: Now raise your arms over your head and then just let them drop into your lap. Good. You may have felt a moment of relaxation when you did that. Your whole body relaxed briefly. Please try it again. You may begin to sense that when you relax that your limbs get heavy. This heaviness is part of relaxation. Now try breathing slowly.
Take a deep breath, hold your breath as you are comfortable, and let it out slowly. Each time you breathe in and out, you will get more and more relaxed. You may want to close your eyes.

The dentist can count while giving breathing and suggestions for relaxation as follows:

Dentist: I would like you to tighten your arm and hand muscles; make them stiff out in front of you. Now as I count, I want you to imagine first tightening and then loosening the muscles. One, feel the muscles of your hands tighten and your arms stiffen. Two, make them really tight. Three, now begin to loosen them a little. Take a deep breath and let it out slowly. Four, imagine your muscles getting heavy and much looser. Take another breath. Five, your arms may not feel so heavy that they begin to fall into your lap.

Once a patient becomes comfortable, the dental work can be started. The dentist should alert the patient about an upcoming noise, bump, or other action. Throughout the procedure the dentist can continue to encourage the patient to maintain the relaxed quiet state.

Often, hypnosis sessions end by the clinician giving the patient posthypnotic suggestions, which usually take the form of praising the patient for doing well and suggesting that the feeling of calm and painlessness of the session will continue in the period after treatment. The patient should be told that practice at home improves the effectiveness of hypnosis.

Source: Dionne RA. 2002. Management of Pain and Anxiety In The Dental Office. W.B. Saunders. Philadelphia

Hypodontia

Hypodontia (oligodontia), the congenital absence of teeth, represented by the loss of one or two teeth with no apparent associated abnormalities is not uncommon. The most common teeth to be missing are the last in each series. Most surveys, however, show that one or more third molars are missing in approximately one-quarter of the population. A study carried out in an English population and excluding the third molars has shown that the teeth most likely to be missing are the lower second premolars (40.9%) followed by the upper lateral incisors (23.5%) and by the upper second premolars (20.9 %).

The pattern of missing teeth does, however, vary from population to population. A common finding in hypodontia is the presence of small and conically shaped teeth replacing normal units of the dentition . Hypodontia in the primary dentition is a relatively rare occurrence.

The congenital absence of teeth associated with abnormalities of the bone or ectodermal appendages is relatively rare. The dysplasia involved may be attributed to ectodermally derived structures or to more complex syndromes in which there are both dermal and bony abnormalities.

Hairy Tongue

Hairy tongue (lingua villosa) is a commonly observed condition of defective desquamation of the filiform papillae that results from a variety of precipitating factors. In hairy tongue the lesion does not consist simply of a coating on the surface of the tongue but represents an elongation of the filiform papillae, often to many times their original length. With this elongation the papillae often take on a dark colour, black or brown being common. The mechanism for the formation of these coloured hairy tongues is quite unknown, there apparently being many initiating factors. For instance, hairy tongue frequently follows a course of antibiotic therapy and may resolve quite rapidly on completion of treatment. Other hairy tongues apparently appear completely spontaneously and no cause is ever found for them. Equally doubtful is the source of the pigment involved. It is usual to relate this to pigment-producing organisms entrapped within the papillae but, in fact, no such organisms have ever been demonstrated. In the past, the presence of hairy tongue was often ascribed to candidal infection but, again, it has never been shown that there is any true association between candidosis and the production of the elongated papillae.

Treatment of hairy tongue is remarkably difficult. Those cases associated with antibiotic therapy frequently, but not invariably, resolve when the medication is finished. The use of effervescent and mucus-solvent mouthwashes may be helpful in reducing secondary irritation and thereby producing suitable conditions for the resolution of the abnormality but, again, the results are variable. The authors have used chemical cauterization, with trichloracetic acid, to treat hairy tongue, but only small areas can be managed at a time, because of discomfort afterwards. Long-term results of this chemical counterization were disappointing. "Sucking a dry peach stone" has been advocated for the management of hairy tongue but this approach does seem to be potentially hazardous! Some patients with this condition use tongue scrapers or brush their tongue vigorously but these measures are rarely effective. 

 
Source :
Field A. 2003. Tyldesley's Oral Medicine. Vol. 5th Ed. Oxford University Press. UK
http://emedicine.medscape.com/article/1075886-overview 
http://www.youtube.com/watch?v=S1lyFPUIkfE 

Tooth decay

What is tooth decay?

Dental caries or tooth decay is one of the most common chronic diseases in the world and affects people of all ages. It is an infectious disease that can be transmitted from one person to another. Cavities are the end result of the disease. The good news is, caries disease is preventable and if treated early, can be treated and controlled. Early caries lesions can even be reversed.

Sensitive Teeth: Why are My Teeth Sensitive and What can I do About It?

If a taste of ice cream or a sip of coffee is sometimes painful or if brushing or flossing makes you wince occasionally, you may have a common problem called "sensitive teeth." Some of the cause include tooth decay, cracked tooth, worn tooth enamel, worn fillings and tooth roots that are exposed as a result of aggressive tooth brushing, gum recession and periodontal (gum disease).

Six Techniques for Managing Behaviour in Pediatric Dentistry

Voice control

Voice control is a controlled alteration of voice volume, tone, or pace to influence and direct the patient's behaviour.

Objectives:
(i) To gain the patient's attention and compliance.
(ii) To avert negative or avoidance behaviour.
(iii) To establish appropriate adult-child roles.

Indications: May be used with any patient.

Contraindications: None.

Painful Socket (Dry Socket)

Dry socket, the most common postoperative complication from tooth extractions is characterized by the partial or total premature loss of a blood clot that forms after extraction, exposed bone and nerves to outside, results in severe pain and delay the healing process.

In normal condition, after extraction, blood clot forms inside a socket (a hole in the bone where the tooth has been removed) and the healing process begins. During the first 24 hours, a fibrin-covered clot adheres to the socket bone.  Within 3-4 days, fibroblasts form and the clot is stabilized.  The clot is slowly replaced by granulation tissue.  In approximately 1 month, the socket is filled with new bone. 

After a Tooth Extraction: How to Take a Proper Care of Your Mouth

After an extraction, it's important for a blood clot to form to stop the bleeding and begin the healing process. That's why your dentist will ask you to bite on a gauze pad for 30 to 45 minutes after an extraction. If bleeding or oozing continues after you remove the gauze pad, place another gauze pad on the area and bite firmly for another 30 minutes. You may have to do this several times.

Topical Therapy for Lesions of The Oral Mucosa

Topical therapy has several advantages over the systemic administration of drugs. Side-effects, although not eliminated, are usually reduced and local application allows for maximum concentration of the drug at the site of the lesion. Agents tend to be more effective if they can be retained locally for as long as possible.

Submandibular Gland Resection

EMBRYOLOGY

The paired submandibular glands develop from the buds in the floor of the primitive mouth that grow on the lateral aspect of the tongue. The buds initially give rise to cords that canalize into ducts, and their ends differentiate into the acinar structures.

Caring For Dentures

Taking proper care of your dentures is important for keeping them in proper shape and also to keep your mouth healthy. Maintaining and keeping your dentures hygienic does not require any special attention. Once you receive your dentures, your dentist will tell you that they need regular cleaning and care. Here is a step-by-step procedure to keep your dentures clean and healthy.

Type of Dental Braces

Dental braces are no longer for teenagers only. An increasing number of adults are choosing braces to straighten their teeth. According to the American Association of Orthodontists, about 22 percent of braces wearers are adults. You can select from these four types of braces to acquire that perfect smile.

Metal braces

The most inexpensive type of braces for adults are the traditional, stainless-steel versions. Obviously, the drawback to wearing these is how visible they are. Metal braces hold a thin wire held in place with rubber bands to put pressure on the teeth and move them to the desired place.

Exfoliative cheilitis

Exfoliative cheilitis is an uncommon condition affecting only the vermilion borders of the lips and characterized by the production of excessive amounts of keratin. This forms brown scales that may be spontaneously shed or may be removed by the patient. It has been suggested that this condition is exclusively seen in female patients, but several cases have recently been reported in males. The histology of the lesion is of a simple hyperparakeratosis and it is not considered to be a premalignant lesion.

How Important Good Oral Health During Pregnancy?

It's no secret that pregnancy is an important time in a woman's life. While women often hear about how pregnancy causes physical changes that affect their hormone or appetite levels, these changes can have a great effect on their oral health as well. Despite the fact that good oral health is essential for the overall health of both mother and child, only 22 to 34 percent of women in the United States visit a dentist during pregnancy.


In fact, dental care during pregnancy is not only safe and effective, it's essential for combating the adverse effects of oral disease, according to an article published in the May/June 2010 issue of General Dentistry, the peer-reviewed clinical journal of the Academy of General Dentistry (AGD). Dentists have the ability to maintain the oral health of expectant mothers by treating the dental findings that are common during pregnancy.

Thumb Sucking: How to Help Your Child Stop the Habit

Children suck their thumbs for a variety of reasons. For infants, it is a natural reflex that often begins in the womb. As babies grow, they learn a lot about their bodies and the world around them through sucking. They suck on their fingers, clothing, and toys. From this action they learn what is pleasing and what is uncomfortable. Sucking on an ice cube or cool teething ring feels good when those first teeth are trying to break through, but when the same teething child sucks on a hard plastic toy, she may experience discomfort.

The Salivary Glands

The parotid glands are the largest salivary glands. They are wedge-shaped and situated in front of the ear and behind the ramus of the mandible. The apex of the wedge is the deepest part of the gland. The peripheral branches of the facial nerve (CN VII) are intimately associated with the parotid gland. This relationship is inadvertently demonstrated when an inferior dental nerve anaesthetic block is administered incorrectly, and causes a temporary drooping of the upper eye lid.

Classes of Human Teeth: Form and Function

Human teeth are divided into classes on the basis of form and function. Both the primary and permanent
dentitions include incisor, canine, and molar classes. The fourth class, the premolar, is found only in the permanent dentition. Tooth form predicts the function of teeth; therefore class traits are the characteristics that place teeth into functional categories. Since the diet of humans consists of both animal and vegetable foods, the human dentition is called omnivorous.

What To Do After Periodontal Pack/Dental Root Canal

The following information on your gum operation has been prepared to answer questions you may have about how to take care of your mouth. Please read the instructions carefully you have found them very helpful.

Early Childhood Caries (Baby Bottle Tooth Decay)

Early childhood caries, also known as baby bottle caries, baby bottle tooth decay, and bottle rot, is a syndrome characterized by severe decay in the teeth of infants or young children. Early childhood caries (ECC) is a very common bacterial infection. Its prevalence is epidemic; in the US its rate is highest in minority and rural populations, at times infecting over 70% of the children. A large body of scientific evidence indicates that ECC is an infectious and transmissible disease, with Streptococcus mutans the primary microbiological agent in the disease. The disease process begins with the transmission of the bacteria to the child, usually from the primary caretaker. Caretakers with untreated dental disease present a very high risk to their children.

Aphthous Stomatitis

Aphthous ulcer (pron.: /ˈæfθəs/ AF-thəs), also known as a canker sore, is a type of mouth ulcer that presents as a painful open sore inside the mouth^[1] or upper throat characterized by a break in the mucous membrane. Its cause is unknown, but they are not contagious.^[2] The condition is also known as aphthous stomatitis (stomatitis is inflammation of the mucous lining), and alternatively as Sutton's Disease, especially in the case of major, multiple, or recurring ulcers.^[3]

Introducing of Panoramic Dental X-ray

What is Panoramic X-ray?

Panoramic radiography, also called panoramic x-ray, is a two-dimensional (2-D) dental x-ray examination that captures the entire mouth in a single image, including the teeth, upper and lower jaws, surrounding structures and tissues.

What to do with a knocked out tooth?

The accidental loss of a tooth is a serious situation but it can be resolved if we act quickly. Dental avulsion usually occurs after a horizontal shock which removes tooth completely out of the mouth. Following such an accident, dentists recommend these instructions in order to increase chances to keep the avulsed tooth.

How To Use Dental Floss Correctly?

Most people floss only once a day, and many even less often. It is very important that you use the correct way to floss, in order to remove as much dental plaque as possible. The recommended flossing methods are described here : 

Brushing Your Teeth

I have a friend who brushes her teeth only once a day but for 15 minutes. And another who bans her children from eating dried fruit. It seems that no one knows quite what they're meant to be doing. Should you floss, use a tongue scraper – and what exactly is the modified Bass technique? Confused? Here's your step-by-step guide.

Why Should We Brush Our Teeth at Night?

Have you ever thought of your teeth as 32 pearly whites protecting the major gateway to your body? If not, then we highly recommend that you do!

It is important that you keep your mouth germfree, free from cavities and infections. And night brushing is one of the best ways to have a cavity-free mouth. It is so important that you should think of night brushing as one of the best gifts you can give to your teeth and gums.

Mucocele: Mucous Cyst of The Oral Mucosa

Mucocele of the lower lips
(Source : http://img.medscape.com/pi/emed/ckb/dermatology/1048885-1075226-1076717-1076807.jpg)

"Mucocele" is the clinical term used to describe the mucus extravasation phenomenon, as well as the mucus retention cyst. The mucus extravasation phenomenon is due to trauma of the minor salivary gland exxcretory duct, resulting in retention of saliva in the surrounding tissues, and is essentially classified as

Tooth Whitening : Is It Safe?

Teeth whitening (bleaching)

Considering whitening (bleaching) your teeth? Before you do, discuss the possible risks with your dentist – especially if you plan to whiten your teeth using an at-home bleaching system.
Risks associated with tooth whitening include tooth sensitivity and damage to the roots of teeth. Dentists may be able to predict if you will have problems with or sensitivities to the procedure. They also may be able to help you alleviate sensitivity by recommending certain procedures and toothpastes designed to treat sensitive teeth. Dentists can also check for signs of root damage caused by tooth whitening and treat the condition if detected in time.

Brushing teeth after meal: good or bad?

Many people brush more than the recommended number of times per day - especially after a rich meal.

But dentists warn that the extra brushing could be doing more harm than good.


Brushing within half an hour of eating a meal or drinking a cup of coffee could ensure your teeth suffer worse damage.

After drinking fizzy or acidic drinks, the acid burns into the enamel of your teeth - and the layer below the enamel, called 'dentin'.

Classification of Dental Trauma

Fig. 1  Dental Trauma

Traumatic force to the teeth or periodontium can cause destruction in a variety of direction and of a variety of magnitudes. Traumatic injuries often occur. For the sake of clarity, however, each type of injury will be describe individually.

The classification  of dental trauma used is based on the World Health Organization (WHO) classification of diseases and has been modified according to Andreasen's recommendation.

Amelogenesis Imperfecta

Amelogenesis imperfecta is a group of conditions caused by defects in the genes encoding enamel matrix proteins. Classification is complex and based on pattern of inheritance, enamel hypoplasia, hypomineralisation or hypomaturation and appearance; smooth, rough or pitted. At least 16 forms are recognised.

Inheritance can be autosomal dominant, recessive or Xlinked. However, the most common types have an autosomal inheritance and are thought to be caused by mutations in the AMEL X gene, which codes for ameloblastin (C4), enamelin (C4) or tuftelin (Cl).

What Is Oral Medicine?

Oral medicine is generally understood as being the study and non-surgical treatment of the diseases affecting the orofacial tissues, especially the oral mucous membrane, but also other associated tissues and structures such as the salivary glands, bone, and the facial tissues. Oral medicine is predominantly an out-patient speciality. The boundaries of oral medicine are poorly defined. For instance, the investigation of facial pain and other neurological disturbances may be considered to be in the field of oral medicine or of oral surgery. It is the responsibility of the general dental practitioner to diagnose and manage some of these conditions. Others are often better treated in specialist clinics, but the general dental practitioner, to a very great extent, bears the responsibility for the recognition of oral disease at an early stage.